Anemia of chronic disease
Anemia of inflammation; Inflammatory anemia; AOCD; ACD
Anemia is a condition in which the body does not have enough healthy red blood cells. Red blood cells provide oxygen to body tissues. There are many types of anemia.
Anemia of chronic disease (ACD) is anemia that is found in people with certain long-term (chronic) medical conditions that involve inflammation.
Blood is comprised of red blood cells, platelets, and various white blood cells.
Causes
Anemia is a lower-than-normal number of red blood cells in the blood. ACD is a common cause of anemia. Some conditions that can lead to ACD include:
- Autoimmune disorders, such as Crohn disease, systemic lupus erythematosus, rheumatoid arthritis, and ulcerative colitis
- Cancer, including lymphoma and Hodgkin disease
- Long-term infections, such as bacterial endocarditis, osteomyelitis (bone infection), HIV/AIDS, lung abscess, hepatitis B or hepatitis C
Do you feel tired and listless? Do you find your mind drifting during the day? Do you get dizzy or short of breath whenever you climb the stairs? There are a few possible reasons for the way you feel, but you could have anemia. You could even have anemia without noticing any symptoms at all. Anemia is a problem with hemoglobin, a substance in red blood cells that carries oxygen throughout your body. Without enough hemoglobin, your heart and other organs can't get the oxygen they need to work. When your organs slow down, you slow down and you start feeling tired and listless. Many different health conditions can cause anemia, from heavy blood loss during a woman's period, to pregnancy, to an underactive thyroid gland. Healthy red blood cells are made in your bone marrow, the soft tissue in the middle of your bones. Any disease that damages blood marrow, such as lymphoma or leukemia, can also affect your red blood cell production. Anemia can also be caused by an immune system problem that damages red blood cells, or surgery to the stomach or intestines. How do you know if you have anemia? You may feel tired, dizzy, and have trouble concentrating. You may get sick more often. People with anemia often complain of chest pain, headaches, or shortness of breath. Your skin might look pale, like you haven't seen the sun for months. Because these can also be symptoms of other conditions, your doctor will confirm that you have anemia by taking a blood test to check your red blood cell count and hemoglobin level. Blood tests can also look for problems that may be causing your anemia, such as a vitamin or iron deficiency. If you are anemic, it's very important to treat it. When your body isn't getting enough oxygen, it can starve vital organs like your heart. This can lead to a heart attack. How you treat anemia really depends on the cause. If the problem is with your bone marrow, you may take a medicine called erythropoietin, which will help your bone marrow make more red blood cells. If the problem is a vitamin or mineral deficiency, your doctor may prescribe iron, vitamin B12, or folic acid supplements. Or, you may need a blood transfusion to replace damaged red blood cells with healthy ones. How well you do really depends on what's causing your anemia. Call your doctor if you have any symptoms like fatigue or shortness of breath. Once your doctor can find and treat the cause of your anemia, you should have more energy and start feeling like your old self again.
Symptoms
Anemia of chronic disease is often mild. You may not notice any symptoms.
When symptoms occur, they may include:
- Feeling weak or tired
- Headache
- Paleness
- Shortness of breath
Exams and Tests
The health care provider will perform a physical exam.
Anemia may be the first symptom of a serious illness, so finding its cause is very important.
Tests that may be done to diagnose anemia or rule out other causes include:
- Complete blood count
- Reticulocyte count
- Serum ferritin level
- Serum iron level
- C-reactive protein level
- Erythrocyte sedimentation rate
- Bone marrow examination (in rare cases to rule out cancer)
Treatment
Anemia is often mild enough that it does not need treatment. It may get better when the disease that is causing it is treated.
More severe anemia, such as that caused by cancer or HIV/AIDS may require:
- Blood transfusion
- Erythropoietin, a hormone produced by the kidneys, given as a shot
Outlook (Prognosis)
The anemia will improve when the disease that is causing it is treated.
Possible Complications
Discomfort from symptoms is the main complication in most cases. Anemia may lead to a higher risk for death in people with heart failure.
When to Contact a Medical Professional
Contact your provider if you have a long-term (chronic) disorder and you develop symptoms of anemia.
References
Elghetany MT, Banki K. Erythrocytic disorders. In: McPherson RA, Pincus MR, eds. Henry's Clinical Diagnosis and Management by Laboratory Methods. 24th ed. Philadelphia, PA: Elsevier; 2022:chap 33.
Means RT. Approach to the anemias. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 149.
Nayak L, Gardner LB, Little JA. Anemia of chronic diseases. In: Hoffman R, Benz EJ, Silberstein LE, et al, eds. Hematology: Basic Principles and Practice. 7th ed. Philadelphia, PA: Elsevier; 2018:chap 37.
Version Info
Last reviewed on: 1/25/2022
Reviewed by: Todd Gersten, MD, Hematology/Oncology, Florida Cancer Specialists & Research Institute, Wellington, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
